Submitted Successfully!
To reward your contribution, here is a gift for you: A free trial for our video production service.
Thank you for your contribution! You can also upload a video entry or images related to this topic.
Version Summary Created by Modification Content Size Created at Operation
1
Jan Alexander
-- 1982 2023-03-20 20:42:56 |
2 Reference format revised.
Lindsay Dong
 Meta information modification 1982 2023-03-21 01:45:49 |

Video Upload Options

Do you have a full video?
Send video materials Upload full video

Confirm

Are you sure to Delete?
Yes No
Cite
If you have any further questions, please contact Encyclopedia Editorial Office.
Aaseth, J.O.; Alexander, J. Osteoporosis after Sleeve Gastrectomy and Roux-En-Y-gastric Bypass. Encyclopedia. Available online: https://encyclopedia.pub/entry/42365 (accessed on 31 July 2024).
Aaseth JO, Alexander J. Osteoporosis after Sleeve Gastrectomy and Roux-En-Y-gastric Bypass. Encyclopedia. Available at: https://encyclopedia.pub/entry/42365. Accessed July 31, 2024.
Aaseth, Jan O., Jan Alexander. "Osteoporosis after Sleeve Gastrectomy and Roux-En-Y-gastric Bypass" Encyclopedia, https://encyclopedia.pub/entry/42365 (accessed July 31, 2024).
Aaseth, J.O., & Alexander, J. (2023, March 20). Osteoporosis after Sleeve Gastrectomy and Roux-En-Y-gastric Bypass. In Encyclopedia. https://encyclopedia.pub/entry/42365
Aaseth, Jan O. and Jan Alexander. "Osteoporosis after Sleeve Gastrectomy and Roux-En-Y-gastric Bypass." Encyclopedia. Web. 20 March, 2023.
Osteoporosis after Sleeve Gastrectomy and Roux-En-Y-gastric Bypass
Edit
This entry is adapted from the peer-reviewed paper 10.3390/nu15061302

Obesity has become a worldwide epidemic accompanied by adverse health effects. The limited efficiency of traditional weight reduction regimens has led to a substantial increase in the use of bariatric surgery. Sleeve gastrectomy (SG) and Roux-en-Y-gastric bypass (RYGB) are the most used procedures. Preoperatively, the dietary habits of obese individuals might lead to deficiencies in vitamin D and other nutrients affecting bone mineral metabolism. Bariatric surgery with SG or RYGB can aggravate these deficiencies. The various surgical procedures appear to affect nutrient absorption differently. Being purely restrictive, SG may particularly affect the absorption of vitamin B12 and also vitamin D. In contrast, RYGB has a more profound impact on the absorption of fat-soluble vitamins and other nutrients, although both surgical methods induce only a mild protein deficiency. Despite adequate supplementation of calcium and vitamin D, osteoporosis may still occur after the surgery. This might be due to deficiencies in other micronutrients, e.g., vitamin K and zinc. Regular follow-ups with individual assessments and nutritional advice are indispensable to prevent osteoporosis and other adverse postoperative issues.

obesity bariatric surgery osteporosis vitamin D Calcium zinc copper

1. Introduction

Obesity has become a worldwide epidemic accompanied by significant adverse health effects [1]. Psycho-social factors and genetic dispositions, in addition to an unfavorable lifestyle, constitute causal factors for obesity [2]. Lifestyle changes, medications, and surgery are strategies for the management of obesity. In recent years, the therapeutic use of bariatric surgery has increased substantially [3]. Individuals with very high body mass index (BMI > 40 kg/m2) or obese subjects with BMI in the range of 35–40 with one of the obesity-associated complications are elected for surgery. Additionally, patients with type 2 diabetes (T2DM) who have insufficient blood glucose control on traditional therapy may be referred to bariatric surgery even when having a BMI value below 35 kg/m2 [4].
The two most common methods for bariatric surgery today are Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). In SG, the stomach size is reduced, which leads to early satiety and reduced food intake. The RYGB method involves reducing the stomach size as part of an operative creation of a bypass outside the absorptive gut segments [5]. Both the SG and the RYGB procedures have side effects. Several observational studies have reported an increased risk of fractures postoperatively [6]. This has been related to the observations of mineral and micronutrient deficiencies [2][7][8]. The different types of surgeries impact the absorption of nutrients differently. Being purely restrictive, SG predominantly affects the absorption of vitamin B12 and also vitamin D, while RYGB has a more profound impact on the absorption of macro- and micronutrients, including lipid-soluble vitamins [8]. Osteopenia and osteoporosis have especially been attributed to RYGB because of a substantially reduced absorption of calcium and vitamin D [8][9]. However, other deficiencies might also play a role in bone loss. The issue of nutrient deficiencies and supplementation in patients who have undergone bariatric surgery has been addressed by several authors [8][9][10]. In addition, deficiencies in vitamin D and other nutrients before bariatric surgery are common in obese individuals. This  can further aggravate the often-neglected complication of postoperative osteoporosis.

2. Pathogenic Aspects of Bone Loss and Nutrient Deficiencies

Osteoporosis is a serious and debilitating disease characterized by reduced bone mineral mass and changed bone microarchitecture. According to WHO [11], a diagnosis of osteoporosis is made when the bone mineral density (BMD) is 2.5 standard deviations or more below the mean peak BMD for healthy adults, as measured by dual energy X-ray absorption (DXA). “Established osteoporosis” is diagnosed in individuals with at least one fragility fracture. A less severe condition is osteopenia, which is defined as a bone mineral density that is lower than normal but not low enough to be classified as osteoporosis [12]. Usually, osteopenia increases in severity with age and is most prevalent in postmenopausal women. Osteopenia is often referred to as “pre-osteoporosis”. More than 200 million people are presumed to be affected by osteoporosis worldwide [11]. Hip fracture is a common clinical manifestation. At least 2 million hip fractures have been estimated to occur annually. Extrapolations indicate that this incidence will increase approximately fourfold during the next 50 years [11]. Apart from hip fractures, other debilitating fractures, such as a compression fracture of a vertebra, represent severe consequences of osteoporosis. These complications underscore the severity of osteoporosis when they occur after bariatric surgery.
In obese individuals who have undergone bariatric surgery, osteoporosis can be caused by nutrient deficiencies, especially deficiencies in calcium and vitamin D, which may lead to hyperparathyroidism with calcium mobilization from the skeleton. Among the aggravating causes of osteoporosis are systemic inflammations, and it is known that pro-inflammatory cytokines, including IL-6 and TNFα, in addition to nutrient deficiencies, can contribute to bone loss as observed  in other gut disorders such as celiac disease and inflammatory bowel syndrome [13]. Although obesity is accompanied by low-grade inflammation, post-operative osteoporosis in bariatric patients has been solely attributed to nutrient deficiencies.

2.1. Nutrient Deficiencies in Morbid Obesity before Bariatric Surgery

Obese individuals often have reduced sunlight exposure due to low outdoor activity. Even without surgery, secondary hyperparathyroidism may develop in obese individuals due to low vitamin D levels combined with a deficient calcium status [14][15][16]. It has also been reported that increased fat deposits in the body may work as a sink and reduce the circulating levels of fat-soluble vitamins such as vitamin D [17]. In addition, an increased intake of sugar-rich or phosphate-containing soft drinks with reduced milk consumption would lead to a lower intake of milk-derived nutrients, including calcium and vitamin D [18].
Upon referral to bariatric surgery, obese individuals are often diagnosed with preoperative vitamin D deficiency and increased parathyroid hormone levels [19]. Furthermore, a Norwegian study also found subnormal preoperative levels of zinc, copper, and manganese [20]. 

2.2. Postoperative Vitamin Deficiencies Which Can Lead to Bone Loss

Early studies revealed that patients who had undergone bariatric surgery very often became deficient in several nutrients (Figure 1). While only a mild protein deficiency was observed after SG and RYGB [21], several research groups found that bariatric surgery could aggravate or precipitate vitamin D deficiency and lead to bone loss [22]. At least 20% of operated individuals suffered from vitamin D deficiency after 2 years, and the incidence could be significantly higher after 5 years, despite the recommended supplementation with about 15 μg vitamin D3 daily [23][24]. This indicates that higher doses might be needed to prevent vitamin D deficiency. In general, malabsorptive procedures such as RYGB could result in a more severe reduction in vitamin D levels than restrictive surgery [24] due to the bypass of intestinal segments with vitamin D absorption [25].
/media/item_content/202303/6418fd94ae5a7nutrients-15-01302-g001.png
Figure 1. Postoperative development of nutrient deficiencies complicated with bone loss and/or other health issues (schematic). Among other health issues are anemia, fatigue, poor wound healing, hair loss, and neurological symptoms.
It is well known that postoperative deficiency of vitamin B12 can lead to anemia [26][27]. Still more importantly, vitamin B12 deficiency has been associated with osteoporosis, which was reported in a systematic review by Macedo et al. [28]. Today, postoperative vitamin B12 supplementation is routinely recommended following bariatric surgery [29]. Folic acid deficiency (vitamin B9) is also reported after bariatric surgery [30][31]. Notably, folate deficiency has been associated with reduced bone health due to disturbed collagen crosslinking [32]. This deficiency can easily be corrected by oral supplementation, routinely administered as a multivitamin tablet taken daily.

2.3. Postoperative Mineral and Trace Element Deficiencies Which Can Accelerate Bone Loss

It is the mineral content that gives bones their rigidity. Bone contains a crystalline hydroxylapatite phase embedded in a flexible organic matrix, the latter being composed of collagenous fibers. A simplified expression of the composition of the mineral crystals is given by the formula: Ca10(PO4)6(OH)2. However, each of these interacting chemical components may, to some extent, be exchanged with other elements in vivo, which may strengthen or weaken the bone tissue [33]. Thus, calcium ions can be substituted by other bivalent metal ions, such as magnesium, strontium, or zinc ions. Furthermore, the first-line therapeutic agents, viz. the bisphosphonates, that exert protective effects on bone tissue may interact with calcium at the superficial bone layers, exchanging with the phosphate anions. The univalent hydroxyl moiety in hydroxylapatite may, to some extent, be substituted by other anions, such as fluoride.
Several metals other than calcium have been reported to be important for bone health, either as components in the crystalline phase or as parts of metalloenzymes. It is well known that magnesium, among other functions, is built into the crystal structure of bone. Magnesium deficiency may contribute to the development of osteopenia and osteoporosis [20][34], indicating that calcium supplementation should be combined with an adequate magnesium intake. In addition, copper (Cu), manganese (Mn), and zinc (Zn) are essential for bone formation [35][36]. It may be suggested that supplementation of zinc, and also of copper and manganese, could add to the beneficial effect of calcium supplementation in selected subjects with osteopenia or osteoporosis. Not much is known about the role of low iron (Fe) in bone metabolism, although it has been observed in mice that iron overload induces increased bone resorption [37].

3. Postoperative Osteopenia and Osteoporosis

Even in the absence of bariatric surgery, obese individuals may have an increased risk of hip fractures, as recorded after the age of sixty [38], which has been attributed to a deficient vitamin D status [39][40]. Bariatric surgery, which uses stomach size reduction, such as SG, in the same way as the use of proton pump inhibitors, seems to represent an increased risk of reduced bone health due to impaired micronutrient uptake [41]. However, osteoporosis after bariatric surgery has particularly been observed after RYGB and is considered to be related to substantially reduced absorption of both calcium and vitamin D [42]. Bypass of the duodenum and proximal jejunum, which are gut segments with particularly high calcium absorption, is thought to predispose patients to postoperative osteoporosis [43]. Insufficient status of zinc and vitamin K may, in addition to that of vitamin D and calcium, be responsible for accelerated postoperative bone loss and an increased rate of fractures [33][44]. Supplements of essential trace nutrients, including zinc, to improve bone density have been recommended [45]. Copper is also linked to bone metabolism, which has been noticed under severe copper-deficient conditions [46][47].
As regards the pathogenesis of postbaratric osteoporosis, it is of interest that a significant loss of bone mineral density (BMD) in the hip and lumbar spine was observed during the first postoperative year by Hofsø et al. [48] in a recent Norwegian study. The bone loss occurred especially after RYGB, despite adequate supplementation with vitamin D3, about 40 μg/day, after dose adjustments guided by 25-OH-vitamin D plasma values [48]. Their observations could indicate that either the weight loss itself or an insufficient status of vitamin K or zinc could play a role in bone deterioration [20][44]. It is known that weight loss after bariatric surgery takes place during the first postoperative year, after which the weight is kept essentially stable during the next couple of years [26]. However, the bone loss also continued during the second postoperative year [49], indicating that the weight loss itself did not cause a decline in bone mineral density (BMD) [44]. 
Altogether, postoperative osteoporosis appears to be the complex result of several nutrient deficiencies. It is strongly recommended to undertake follow-ups with determinations of BMD (densitometry) and biomarkers of bone metabolism, as well as nutrient assessments for all bariatric patients at regular intervals. At the very least, BMD determination should be conducted as part of a routine examination two years after the bariatric surgery. The most widely used biomarkers for bone formation and bone resorption are P1NP (propeptide of type 1 collagen) and CTX (the C-terminal telopeptide), respectively, the blood plasma levels of both these markers being typically increased during ongoing bone loss [50]. For prevention, the bisphosphonate zoledronate, when given as monotherapy, has been found insufficient [51], which further underscores the importance of individualized evaluation and specific dietary supplements. Measurement of 25-OH-vitamin D at the preoperative control is highly recommended, and adequate supplementation should be initiated. At the postoperative follow-ups, it is advised to conduct an extensive examination, including determinations of calcium, albumin, phosphate, and PTH, as well as bone densitometry in individual patients.

References

  1. Bluher, M. Obesity: Global epidemiology and pathogenesis. Nat. Rev. Endocrinol. 2019, 15, 288–298.
  2. Casimiro, I.; Sam, S.; Brady, M.J. Endocrine implications of bariatric surgery: A review on the intersection between incretins, bone, and sex hormones. Physiol. Rep. 2019, 7, e14111.
  3. Angrisani, L.; Santonicola, A.; Iovino, P.; Vitiello, A.; Higa, K.; Himpens, J.; Scopinaro, N.I.F.S.O. IFSO worldwide survey 2016: Primary, endoluminal, and revisional procedures. Obes. Surg. 2018, 28, 3783–3794.
  4. Dixon, J.B.; Zimmet, P.; Alberti, K.G.; Rubino, F. Bariatric surgery: An IDF statement for obese type 2 diabetes. Diabetes Med. 2011, 28, 628–642.
  5. Buchwald, H.; Oien, D.M. Metabolic/bariatric surgery worldwide 2008. Obes. Surg. 2009, 19, 1605–1611.
  6. Saad, R.K.; Ghezzawi, M.; Habli, D.; Alami, R.S.; Chakhtoura, M. Fracture risk following bariatric surgery: A systematic review and meta-analysis. Osteoporos. Int. 2022, 33, 511–526.
  7. Krzizek, E.C.; Brix, J.M.; Herz, C.T.; Kopp, H.P.; Schernthaner, G.H.; Schernthaner, G.; Ludvik, B. Prevalence of micronutrient deficiency in patients with morbid obesity before bariatric surgery. Obes. Surg. 2018, 28, 643–648.
  8. Hewitt, S.; Aasheim, E.T.; Søvik, T.T.; Jahnsen, J.; Kristinsson, J.; Eriksen, E.F.; Mala, T. Relationships of serum 25-hydroxyvitamin D, ionized calcium and parathyroid hormone after obesity surgery. Clin. Endocrinol. 2018, 88, 372–379.
  9. Paccou, J.; Caiazzo, R.; Lespessailles, E.; Cortet, B. Bariatric surgery and osteoporosis. Calcif. Tissue Int. 2022, 110, 576–591.
  10. Bernert, C.P.; Ciangura, C.; Coupaye, M.; Czernichow, S.; Bouillot, J.L.; Basdevant, A. Nutritional deficiency after gastric bypass: Diagnosis, prevention and treatment. Diabetes Metab. 2007, 33, 13–24.
  11. WHO Scientific Group on Prevention; Management of Osteoporosis; World Health Organization. Prevention and Management of Osteoporosis: Report of a WHO Scientific Group; No. 921; World Health Organization: Geneva, Switzerland, 2003.
  12. Karaguzel, G.; Holick, M.F. Diagnosis and treatment of osteopenia. Rev. Endocr. Metab. Disord. 2010, 11, 237–251.
  13. Franco, C.B. Osteoporosis in gastrointestinal diseases. Transl. Gastrointest. Cancer 2014, 4, 57–68.
  14. Xanthakos, S.A. Nutritional deficiencies in obesity and after bariatric surgery. Pediatr. Clin. 2009, 56, 1105–1121.
  15. Pereira-Santos, M.; Costa, P.D.F.; Assis, A.D.; Santos, C.D.S.; Santos, D.D. Obesity and vitamin D deficiency: A systematic review and meta-analysis. Obes. Rev. 2015, 16, 341–349.
  16. Ghergherechi, R.; Hazhir, N.; Tabrizi, A. Comparison of vitamin D deficiency and secondary hyperparathyroidism in obese and non-obese children and adolescents. Pak. J. Biol. Sci. PJBS 2012, 15, 147–151.
  17. Gillis, L.; Gillis, A. Nutrient inadequacy in obese and non-obese youth. Can. J. Diet. Pract. Res. 2005, 66, 237–242.
  18. Dennis, E.A.; Flack, K.D.; Davy, B.M. Beverage consumption and adult weight management: A review. Eat. Behav. 2009, 10, 237–246.
  19. Schweiger, C.; Weiss, R.; Berry, E.; Keidar, A. Nutritional deficiencies in bariatric surgery candidates. Obes. Surg. 2010, 20, 193–197.
  20. Mikalsen, S.M.; Aaseth, J.; Flaten, T.P.; Whist, J.E.; Bjørke-Monsen, A.L. Essential trace elements in Norwegian obese patients before and 12 months after Roux-en-Y gastric bypass surgery: Copper, manganese, selenium and zinc. J. Trace Elem. Med. Biol. 2020, 62, 126650.
  21. Bloomberg, R.D.; Fleishman, A.; Nalle, J.E.; Herron, D.M.; Kini, S. Nutritional deficiencies following bariatric surgery: What have we learned? Obes. Surg. 2005, 15, 145–154.
  22. Blom-Høgestøl, I.K.; Hewitt, S.; Chahal-Kummen, M.; Brunborg, C.; Gulseth, H.L.; Kristinsson, J.A.; Mala, T. Bone metabolism, bone mineral density and low-energy fractures 10 years after Roux-en-Y gastric bypass. Bone 2019, 127, 436–445.
  23. Chakhtoura, M.T.; Nakhoul, N.N.; Shawwa, K.; Mantzoros, C.; Fuleihan, G.A.E.H. Hypovitaminosis D in bariatric surgery: A systematic review of observational studies. Metabolism 2016, 65, 574–585.
  24. Hewitt, S.; Søvik, T.T.; Aasheim, E.T.; Kristinsson, J.; Jahnsen, J.; Birketvedt, G.S.; Mala, T. Secondary hyperparathyroidism, vitamin D sufficiency, and serum calcium 5 years after gastric bypass and duodenal switch. Obes. Surg. 2013, 23, 384–390.
  25. Lespessailles, E.; Toumi, H. Vitamin D alteration associated with obesity and bariatric surgery. Exp. Biol. Med. 2017, 242, 1086–1094.
  26. Lupoli, R.; Lembo, E.; Saldalamacchia, G.; Avola, C.K.; Angrisani, L.; Capaldo, B. Bariatric surgery and long-term nutritional issues. World J. Diabetes 2017, 8, 464.
  27. Lewis, C.A.; de Jersey, S.; Seymour, M.; Hopkins, G.; Hickman, I.; Osland, E. Iron, vitamin B12, folate and copper deficiency after bariatric surgery and the impact on anaemia: A systematic review. Obes. Surg. 2020, 30, 4542–4591.
  28. Macêdo, L.L.G.D.; Carvalho, C.M.R.G.D.; Cavalcanti, J.C. Vitamin B12, bone mineral density and fracture risk in adults: A systematic review. Rev. Da Assoc. Médica Bras. 2017, 63, 801–809.
  29. Patel, R.; Saumoy, M. Treatment of Micronutrient Deficiencies Pre and Post Bariatric Surgery. Curr. Treat. Options Gastroenterol. 2021, 19, 169–182.
  30. Al-Jafar, H.; Al-Zamil, K.; Al Ageeli, M.; Alhaifi, M.; Al-Sabah, S. Potential hematology and nutritional complications of bariatric surgery. Ann. Hematol. Oncol. 2018, 5, 1209.
  31. Antoniewicz, A.; Kalinowski, P.; Kotulecka, K.J.; Kocoń, P.; Paluszkiewicz, R.; Remiszewski, P.; Zieniewicz, K. Nutritional deficiencies in patients after Roux-en-Y gastric bypass and sleeve gastrectomy during 12-month follow-up. Obes. Surg. 2019, 29, 3277–3284.
  32. Herrmann, M.; Peter Schmidt, J.; Umanskaya, N.; Wagner, A.; Taban-Shomal, O.; Widmann, T.; Herrmann, W. The role of hyperhomocysteinemia as well as folate, vitamin B6 and B12 deficiencies in osteoporosis–a systematic review. Clin. Chem. Lab. Med. 2007, 45, 1621–1632.
  33. Aaseth, J.; Boivin, G.; Andersen, O. Osteoporosis and trace elements—An overview. J. Trace Elem. Med. Biol. 2012, 26, 149–152.
  34. Castiglioni, S.; Cazzaniga, A.; Albisetti, W.; Maier, J.A. Magnesium and osteoporosis: Current state of knowledge and future research directions. Nutrients 2013, 5, 3022–3033.
  35. Galchenko, A.; Gapparova, K.; Sidorova, E. The influence of vegetarian and vegan diets on the state of bone mineral density in humans. Crit. Rev. Food Sci. Nutr. 2021, 63, 845–861.
  36. Bae, Y.J.; Kim, M.H. Manganese supplementation improves mineral density of the spine and femur and serum osteocalcin in rats. Biol. Trace Elem. Res. 2008, 124, 28–34.
  37. Tsay, J.; Yang, Z.; Ross, F.P.; Cunningham-Rundles, S.; Lin, H.; Coleman, R.; Vogiatzi, M.G. Bone loss caused by iron overload in a murine model: Importance of oxidative stress. Blood J. Am. Soc. Hematol. 2010, 116, 2582–2589.
  38. Søgaard, A.J.; Holvik, K.; Omsland, T.K.; Tell, G.S.; Dahl, C.; Schei, B.; Meyer, H.E. Abdominal obesity increases the risk of hip fracture. A population-based study of 43,000 women and men aged 60–79 years followed for 8 years. Cohort of N orway. J. Intern. Med. 2015, 277, 306–317.
  39. Turer, C.B.; Lin, H.; Flores, G. Prevalence of vitamin D deficiency among overweight and obese US children. Pediatrics 2013, 131, e152–e161.
  40. Vranić, L.; Mikolašević, I.; Milić, S. Vitamin D deficiency: Consequence or cause of obesity? Medicina 2019, 55, 541.
  41. Briganti, S.I.; Naciu, A.M.; Tabacco, G.; Cesareo, R.; Napoli, N.; Trimboli, P.; Palermo, A. Proton pump inhibitors and fractures in adults: A critical appraisal and review of the literature. Int. J. Endocrinol. 2021, 2021, 8902367.
  42. Finnes, T.E.; Lofthus, C.M.; Meyer, H.E.; Søgaard, A.J.; Tell, G.S.; Apalset, E.M.; Holvik, K. A combination of low serum concentrations of vitamins K1 and D is associated with increased risk of hip fractures in elderly Norwegians: A NOREPOS study. Osteoporos. Int. 2016, 27, 1645–1652.
  43. Saad, R.; Habli, D.; El Sabbagh, R.; Chakhtoura, M. Bone health following bariatric surgery: An update. J. Clin. Densitom. 2020, 23, 165–181.
  44. Hao, G.; Zhang, B.; Gu, M.; Chen, C.; Zhang, Q.; Zhang, G.; Cao, X. Vitamin K intake and the risk of fractures: A meta-analysis. Medicine 2017, 96, e6725.
  45. Yamaguchi, M. Role of nutritional zinc in the prevention of osteoporosis. Mol. Cell. Biochem. 2010, 338, 241–254.
  46. Zheng, J.; Mao, X.; Ling, J.; He, Q.; Quan, J. Low serum levels of zinc, copper, and iron as risk factors for osteoporosis: A meta-analysis. Biol. Trace Elem. Res. 2014, 160, 15–23.
  47. Marquardt, M.L.; Done, S.L.; Sandrock, M.; Berdon, W.E.; Feldman, K.W. Copper deficiency presenting as metabolic bone disease in extremely low birth weight, short-gut infants. Pediatrics 2012, 130, e695–e698.
  48. Hofsø, D.; Hillestad, T.O.W.; Halvorsen, E.; Fatima, F.; Johnson, L.K.; Lindberg, M.; Hjelmesæth, J. Bone mineral density and turnover after sleeve gastrectomy and gastric bypass: A randomized controlled trial (Oseberg). J. Clin. Endocrinol. Metab. 2021, 106, 501–511.
  49. Brzozowska, M.M.; Tran, T.; Bliuc, D.; Jorgensen, J.; Talbot, M.; Fenton-Lee, D.; Center, J.R. Roux-en-Y gastric bypass and gastric sleeve surgery result in long term bone loss. Int. J. Obes. 2021, 45, 235–246.
  50. Svanevik, M.; Risstad, H.; Hofsø, D.; Blom-Høgestøl, I.K.; Kristinsson, J.A.; Sandbu, R.; Hjelmesæth, J. Bone turnover markers after standard and distal Roux-en-Y gastric bypass: Results from a randomized controlled trial. Obes. Surg. 2019, 29, 2886–2895.
  51. Liu, Y.; Côté, M.M.; Cheney, M.C.; Lindeman, K.G.; Rushin, C.C.; Hutter, M.M.; Elaine, W.Y. Examining zoledronic acid for the prevention of bone loss in patients receiving bariatric surgery. Bone Rep. 2021, 14, 100760.
More
© Text is available under the terms and conditions of the Creative Commons Attribution (CC BY) license; additional terms may apply. By using this site, you agree to the Terms and Conditions and Privacy Policy.
Upload a video for this entry
Information
Subjects: Gastroenterology & Hepatology; Nutrition & Dietetics
Contributors MDPI registered users' name will be linked to their SciProfiles pages. To register with us, please refer to https://encyclopedia.pub/register :
Jan O. Aaseth
,
Jan Alexander
View Times: 315
Revisions: 2 times (View History)
Update Date: 21 Mar 2023
Table of Contents
    1000/1000
    Hot Most Recent
    Video Production Service
    Feedback